Family Courts Rules 2002

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Schedule 2
Forms for Proceedings under Adoption Act 1955

Form A 1
Front page for documents filed in Court under Adoption Act 1955

r 72(1)(a), 241(1)

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Form A 2
Heading of documents issued by Court or Registrar under Adoption Act 1955

r 73(1)(a), 241(1)

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Form A 3
Application for adoption order

r 241(1)

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(Front page—Form A 1) We (or I), [full name(s)], of [address], [occupation], will apply to the Family Court at [place] on [to be filled in by the Registrar] [date], [time], to adopt [* Name may be omitted if applicants so wish. full name] a [sex] child, born at [place] on [date]. We desire that on the making of the adoption order the names of the child will be [full name]. The following information is submitted for the purposes of re-registration of the birth: Age of male applicant at date of child's birth: Birthplace of male applicant: Age of female applicant at date of child's birth: Birthplace of female applicant: Maiden surname of female applicant: * Delete if inapplicable. We (do not) desire that the words adoptive parent(s) appear on the face of any certified copy of the entry of birth of the child after the birth has been re-registered. Dated at [place], [date] Signature Signature

Form A 4
Consent to adoption order

r 246(1)

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[General form] (Front page—Form A 1) We (or I), [full name(s)], of [address], [occupation], the parents (or the mother or the father or the guardian) of [full name], a [sex] child, born at [place] on [date], consent to an order being made for the adoption of that child by [full name], of [address], [occupation], * Delete if inapplicable. and [full name], [address], [occupation], his (or her) spouse. [If required under rule 245(1)(a),] a copy of the entry in the register of births relating to the said child is annexed.] We (or I) have read the explanation of the effect of an order set out below. Signed by [full name] on [date], in the prescence of † Witness must be 1 of the persons specified in section 7(8) of the Adoption Act 1955, but not the lawyer acting for the applicants. — ) ) A B [occupation and address]. Signed by [full name] on [date], in the prescence of— ) ) C D [occupation and address]. Effect of adoption order On the making of an adoption order,— a the child is deemed for all purposes and as regards all relationships to become a child of the adoptive parents: b rights of guardianship and existing relationships in respect of the child cease except for the very special purpose of determining forbidden relationships in connection with marriage and with the crime of incest: c rights in respect of property and succession to property are determined according to the relationships created by the adoption, but property rights acquired before the adoption are not affected:

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d any paternity order or maintenance order or agreement that provides for maintenance of the child, if made before the adoption order, ceases to have any effect except as to arrears owing and except if the child is adopted by the mother or by the mother and her husband. However, if the child is adopted by the mother or by the mother and her husband, the adoption does not prevent the making of any paternity order or main- tenance order that could previously have been made or prevent the mother from making an application for a paternity order or a maintenance order: e the domicile of the child is changed to that of the adoptive parents, but the child's race and nationality are not affected: f the child must be treated as a New Zealand citizen by birth if at least 1 of the adoptive parents is a New Zealand citizen. Certificate by witness I certify that, before [full name(s)] signed the consent set out above, I fully explained to him (or her or them) the effect of the making of an adoption order as set out in the Adoption Act 1955, and that he (or she or they) appeared to fully understand that effect. Signature Date

  • Form A 4 was amended, as from 26 April 2005, by section 8(1) Relationships (Statutory References) Act 2005 (2005 No 3) by inserting the words or civil union after the word marriage wherever it appears.

  • Form A 4 was amended, as from 1 July 2005, by rule 32(1) Family Courts Amendment Rules 2005 (SR 2005/101) by substituting the word presence for the word prescence in both places where it occurs.

Form A 5
Consent to adoption order

r 246(1)

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[If identity of applicants is not known] (Front page—Form A 1) We (or I), [full name(s)], of [address], [occupation], the parents (or the mother or the father or the guardian) of [full name], a [sex] child, born at [place] on [date], consent to an order being made for the adoption of that child by the applicant or applicants named in Application No [specify number] (or the person(s) who are (or is) entitled to receive that child for adoption in accordance with an approval that was given on [date] by [full name], a social worker), * Delete if inapplicable. subject to the following conditions in relation to the religious denominations and practice of the applicants or any applicant or as to the religious denominations in which the applicant or applicants intend to bring up the child: [set out conditions]. [If required under rule 245(1)(a),] a copy of the entry in the register of births relating to the said child is annexed. We (or I) have read the explanation set out below of the effect of an order. Signed by [full name] on [date], in the presence of † Witness must be 1 of the persons specified in section 7(8) of the Adoption Act 1955, but not the lawyer acting for the applicants. — ) ) A B [occupation and address]. Signed by [full name] on [date], in the presence of— ) ) C D [occupation and address]. Effect of adoption order On the making of an adoption order,— a the child is deemed for all purposes and as regards all relationships to become a child of the adoptive parents:

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b rights of guardianship and existing relationships in respect of the child cease except for the very special purpose of determining forbidden relationships in connection with marriage and with the crime of incest: c rights in respect of property and succession to property are determined according to the relationships created by the adoption, but property rights acquired before the adoption are not affected: d any paternity order or maintenance order or agreement that provides for maintenance of the child, if made before the adoption order, ceases to have any effect except as to arrears owing and except if the child is adopted by the mother or by the mother and her husband. However, if the child is adopted by the mother or by the mother and her husband, the adoption does not prevent the making of any paternity order or main- tenance order that could previously have been made or prevent the mother from making an application for a paternity order or a maintenance order: e the domicile of the child is changed to that of the adoptive parents, but the child's race and nationality are not affected: f the child must be treated as a New Zealand citizen by birth if at least 1 of the adoptive parents is a New Zealand citizen. I certify that, before [full name(s)] signed the consent set out above, I fully explained to him (or her or them) the effect of the making of an adoption order as set out in the Adoption Act 1955, and that he (or she or they) appeared to fully understand that effect. Signature Date

  • Form A 5 was amended, as from 26 April 2005, by section 8(1) Relationships (Statutory References) Act 2005 (2005 No 3) by inserting the words or civil union after the word marriage wherever it appears.

  • Form A 5 was amended, as from 1 July 2005, by rule 32(2) Family Courts Amendment Rules 2005 (SR 2005/101) by substituting the word presence for the word prescence in both places where it occurs.

Form A 6
Notice of interim order

r 250(a)

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(Heading—Form A 2) To [full name], of [address], * Delete if inapplicable. and [full name], his (or her) spouse. On [date], the Court made an order in relation to your application to adopt a child. The order was an interim order only, as required by the Adoption Act 1955, and while it remains in force the following conditions apply: a you are entitled to the custody of the child * Delete if inapplicable. on the following terms: b any social worker may, at all reasonable times, visit and enter the residence in which the child is living: c the child must not be taken out of New Zealand without leave of the Court: d you must give to a social worker at least 7 days' notice before changing your residence. However, if an emergency makes any immediate change necessary, it will be sufficient if you give notice within 48 hours after leaving your previous residence. The interim order is not an adoption order. An adoption order cannot be obtained until a further application has been made to the Court after an interval of [specify period]. The application to the Court for the issue of the adoption order may be made after [date] if the child has then been continuously in your care for not less than [specify period] since the date on which the interim order was made or since the earlier date (if any) when the placing or receiving or keeping of the child in your home for the purpose of adoption was approved by a social worker. The application to the Court for the adoption order must be made before [specify date]. The interim order will lapse on that date. If you do not apply in time, you may lose the custody of the child. Registrar Date

  • Form A 6 was amended, as from 1 July 2005, by rule 32(3)(a) Family Courts Amendment Rules 2005 (SR 2005/101) by substituting the words have the role of providing day-to-day care for for the words are entitled to the custody of.

  • Form A 6 was amended, as from 1 July 2005, by rule 32(3)(b) Family Courts Amendment Rules 2005 (SR 2005/101) by substituting the words lose the role of providing day-to-day care for for the words lose the custody of.

Form A 7
Application for issue of adoption order after interim order has been made

r 251

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(Front page—Form A 1) The applicant(s) apply for the issue of an adoption order and state as follows: 1 The interim order is in force and has continued in force for accordance with, section 13 of the Adoption Act 1955]. 2 [If the child is under the age of 15 years, state facts to show that section 13(1)(b) of the Adoption Act 1955 has been complied with.] Dated at [place], [date]. Signature(s) Date To the Registrar Family Court at [place]

Form A 8
Notice of adoption order

r 252(1)

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(Heading—Form A 2) To [name] An adoption order was issued (or made) in respect of [name of child following adoption] on [date]. Registrar Date

Form A 9
Adoption order

r 252(2)

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[If issued by Registrar] (Heading—Form A 2) On the application of [name, address, and occupation], * Delete if inapplicable. and [name, address, and occupation], his (or her) spouse, an interim order was made by [full name], Family Court Judge, for the adoption of [full name], a [sex] child, born at [place] on [date], and the order specified that after the adoption order the child's name would be [full name]. Now it is ordered that the [sex] child be adopted by [full name(s)] and that he (or she) from this date has the name of [full name]. Dated at [place], [date]. [Seal] Registrar

  • Form A 9 was amended, as from 1 July 2005, by rule 32(4) Family Courts Amendment Rules 2005 (SR 2005/101) by substituting the word interim for the word interm.

Form A 10
Adoption order

r 252(2)

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